Organization
DAVID M KANUCK D P M PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M KANUCK DPM (OWNER)
(239) 481-7000
Entity
Organization
Contact information
Practice address
3191 HARBOR BLVD, STE B, PORT CHARLOTTE, FL 33952-6755
(239) 481-7000
(239) 481-8150
Mailing address
8851 BOARDROOM CIR, FORT MYERS, FL 33919-4888
(239) 481-7000
(239) 481-8150
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3295
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN6352
RAILROAD MEDICARE
FL
Enumeration date
06/14/2007
Last updated
03/03/2011
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